The 5 A's Approach for Contextual Assessment of Food Environment

Objective: To develop a context-specific methodology to assess the 5 A's of food environment: availability, accessibility, affordability, acceptability, and accommodation. Design: Cross-sectional mixed-methods study. Availability of foods was assessed by on-site observation and interviewing vendors. To assess accessibility, buffer zones around food stores were created using geographic information systems. Affordability was controlled by selecting participants from the middle-income group. Accommodation and acceptability were assessed by interviewing vendors and caregivers. Setting: Villages of Ghatkesar subdistrict (n = 4), Telangana, South India. Participants: Caregivers of children aged 6-10 years (n = 160) and food vendors (n = 68). Analysis: The quality of the 5 A's was graded on the basis of concurrence between actual and perceived measures. Results: The actual and perceived 5 A's for semiperishable foods matched, and hence the food environment was graded as good across the villages. However, for perishable foods, the food environment was graded as poor with respect to accommodation and acceptability in all villages; and with respect to availability and affordability in at least 2 villages as the actual and perceived measures did not match. Conclusions and Implications: This study demonstrated the use of context-specific methods to assess the 5 key dimensions of the food environment, which can be attempted in other contexts with suitable modifications.